Cardiogenic shock

Handler, Clive

doi:10.1136/pgmj.61.718.705

Cited by 8 publications

(4 citation statements)

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“…Digitalis is characterized as having both positive and negative inotropic effects, and has been traditionally used to improve cardiac function in patients with chronic heart disease. [ 29 ] It has never been recommended for management of any type of shock[ 29 30 31 ] and has a very limited role in the current management of cardiogenic shock. [ 29 ] In contrast, current shock management guidelines recommend that dobutamine be administered in the presence of myocardial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…[ 29 ] It has never been recommended for management of any type of shock[ 29 30 31 ] and has a very limited role in the current management of cardiogenic shock. [ 29 ] In contrast, current shock management guidelines recommend that dobutamine be administered in the presence of myocardial dysfunction. [ 10 11 12 ] Chinese physicians in nonteaching hospitals also made inappropriate choices related to indications or targets for use of vasopressors and inotropes, the use of vasodilators, and seldom used advanced monitoring techniques when compared with their colleagues in teaching hospitals.…”

Section: Discussionmentioning

confidence: 99%

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Extensive Variability in Vasoactive Agent Therapy

Pei

Ma²,

et al. 2015

Chinese Medical Journal

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Background:Inconsistencies in the use of the vasoactive agent therapy to treat shock are found in previous studies. A descriptive study was proposed to investigate current use of vasoactive agents for patients with shock in Chinese intensive care settings.Methods:A nationwide survey of physicians was conducted from August 17 to December 30, 2012. Physicians were asked to complete a questionnaire which focused on the selection of vasoactive agents, management in the use of vasopressor/inotropic therapy, monitoring protocols when using these agents, and demographic characteristics.Results:The response rate was 65.1% with physicians returning 586 valid questionnaires. Norepinephrine was the first choice of a vasopressor used to treat septic shock by 70.8% of respondents; 73.4% of respondents favored dopamine for hypovolemic shock; and 68.3% of respondents preferred dopamine for cardiogenic shock. Dobutamine was selected by 84.1%, 64.5%, and 60.6% of respondents for septic, hypovolemic, and cardiogenic shock, respectively. Vasodilator agents were prescribed by physicians in the management of cardiogenic shock (67.1%) rather than for septic (32.3%) and hypovolemic shock (6.5%). A significant number of physicians working in teaching hospitals were using vasoactive agents in an appropriate manner when compared to physicians in nonteaching hospitals.Conclusions:Vasoactive agent use for treatment of shock is inconsistent according to self-report by Chinese intensive care physicians; however, the variation in use depends upon the form of shock being treated and the type of hospital; thus, corresponding educational programs about vasoactive agent use for shock management should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Extensive Variability in Vasoactive Agent Therapy

Pei

Ma²,

et al. 2015

Chinese Medical Journal

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“…Critically low contractility values lead in the model to a persistent increase in pulmonary venous pressure, which after some model time results in a sharp drop in systolic pressure and SV ( Figure 2C ). We interpret this state as cardiogenic shock ( Hollenberg et al, 1999 ; Handler, 1985 ), since hemodynamic criteria of this clinical condition are sustained hypotension (systolic blood pressure < 90 mmHg for at least 30 min) and a reduced cardiac index (<2.2 L/min per m 2 ) in the presence of elevated pulmonary capillary occlusion pressure (>15 mmHg) ( Hollenberg et al, 1999 ), which serves as an estimate of pulmonary venous pressure ( Grignola, 2011 ; Chaliki et al, 2002 ). An interactive implementation of this example in BioUML is available online (see the Availability section).…”

Section: Methodsmentioning

confidence: 99%

Mathematical modeling of antihypertensive therapy

et al. 2022

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Hypertension is a multifactorial disease arising from complex pathophysiological pathways. Individual characteristics of patients result in different responses to various classes of antihypertensive medications. Therefore, evaluating the efficacy of therapy based on in silico predictions is an important task. This study is a continuation of research on the modular agent-based model of the cardiovascular and renal systems (presented in the previously published article). In the current work, we included in the model equations simulating the response to antihypertensive therapies with different mechanisms of action. For this, we used the pharmacodynamic effects of the angiotensin II receptor blocker losartan, the calcium channel blocker amlodipine, the angiotensin-converting enzyme inhibitor enalapril, the direct renin inhibitor aliskiren, the thiazide diuretic hydrochlorothiazide, and the β-blocker bisoprolol. We fitted therapy parameters based on known clinical trials for all considered medications, and then tested the model’s ability to show reasonable dynamics (expected by clinical observations) after treatment with individual drugs and their dual combinations in a group of virtual patients with hypertension. The extended model paves the way for the next step in personalized medicine that is adapting the model parameters to a real patient and predicting his response to antihypertensive therapy. The model is implemented in the BioUML software and is available at https://gitlab.sirius-web.org/virtual-patient/antihypertensive-treatment-modeling.

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“…Cardiogenic shock is a cardiac disorder that results in clinical and biochemical evidence of tissue hypoperfusion [1]. Aortic stenosis (AS) is one of the many causes of cardiogenic shock, as it causes obstruction to left ventricular outflow [2], complicated by an already hypertrophied left ventricle, due to chronically increased afterload, with resulting systolic and diastolic dysfunction and reduced coronary flow reserve (“burn out” phase) [3-4]. Attempts to treat medically patients presenting with cardiogenic shock and severe aortic stenosis are largely unsuccessful, with high mortality [3].…”

Section: Introductionmentioning

confidence: 99%

Balloon Aortic Valvuloplasty in Patients Admitted for Cardiogenic Shock with Severe Aortic Stenosis: A Retrospective Analysis of 14 Cases

Varela

Teixeira

Ponte

et al. 2019

Cureus

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IntroductionBalloon aortic valvuloplasty (BAV), introduced in 1986, quickly lost its wide adoption due to the high incidence of restenosis after the procedure and due to improved skills in transcatheter aortic valve implantation (TAVI). It has seen a re-emergence in the last few years as bailout therapy in critical care patients presenting with cardiogenic shock (CS) and severe aortic stenosis (AS), who are temporarily unable to tolerate such a procedure as TAVI or surgery for valve replacement.MethodsWe did a retrospective analysis of every BAV performed between January 1, 2008, and November 11, 2018, in our hospital and identified those admitted to the cardiac intensive care unit (CICU) due to cardiogenic shock with severe aortic stenosis, as defined in the European Society of Cardiology Guidelines. Procedures were categorized as emergent (within 24h after the decision to intervene) and urgent (24h after the decision was made but before discharge).ResultsDuring this period, of 98 BAV performed, 14 were performed on patients with CS with severe AS, nine of them being emergent. The patients’ mean age was 76.2±7.2 years, with 6 (43%) of them being female.On the day of BAV, the mean Euroscore II and sequential organ failure (SOFA) were, respectively, 19±7% and 8.0±2.4 in emergent cases and 11±5% and 4.8±2.9 in urgent cases. In patients deemed emergent, there was a tendency for a decrease in SOFA in the days following the procedure, although not statistically significant (p>0.05). Clinically significant aortic regurgitation did not occur in any patient, neither were there any major post-procedure complications. Thirty-day mortality was 33% in emergent cases and 0% in urgent cases.In emergent cases, four were later submitted to TAVI and one had surgery for aortic valve replacement surgery. Only one patient in the urgent group was regarded as a candidate for TAVI.Discussion and conclusionEmergent cases presented with higher scores of severity and procedure risk and had greater mortality. In this group, a greater proportion of survivors was later deemed fit for definite procedures. This highlights that presenting status does not seem to influence the prognosis of those extremely high-risk patients once the acute event is promptly treated. Nevertheless, the low sample size precludes generalization of the findings.BAV as bailout treatment may be safe in patients presenting with CS and severe AS, allowing patient survival for elective definitive treatment.

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Cardiogenic shock

Cited by 8 publications

References 54 publications

Extensive Variability in Vasoactive Agent Therapy

Extensive Variability in Vasoactive Agent Therapy

Mathematical modeling of antihypertensive therapy

Balloon Aortic Valvuloplasty in Patients Admitted for Cardiogenic Shock with Severe Aortic Stenosis: A Retrospective Analysis of 14 Cases

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